In February 2008 Mesothelioma UK secured funding for a national mesothelioma chemotherapy audit.
Mesothelioma is a rare cancer which, in most cases, can be attributed to previous exposure to asbestos. Mesothelioma has a grim prognosis, although some patients live for a number of years, most patients sadly die within eighteen months of diagnosis.
Although more prevalent in areas with a maritime or industrial background, mesothelioma is found nationwide in the UK, however, there are no mandated national guidelines for treatment and due to the rare nature of the disease, clinicians may only see a very small number of patients each year.
This means that mesothelioma patients are essentially in a lottery as to what treatment will be offered, depending on their location, the progression of their cancer and the health authority they receive treatment from.
On 1st November 2004 Lilly UK, a pharmaceutical research, development and manufacturing company announced that Alimta® (Pemetrexed) would shortly be available for treatment of mesothelioma. Combined with Cisplatin, Alimta® was to be the first licensed chemotherapy treatment for malignant pleural mesothelioma. It took more than three years for approval of the treatment on the NHS but in January 2008 this came through.
The drug approval process highlighted issues in the treatment of mesothelioma. One of the main issues was the variation in treatments being offered by different clinicians across the country. In light of this, Mesothelioma UK, a prominent mesothelioma charity, secured funding to carry out a national mesothelioma chemotherapy audit.
The Chemotherapy in Mesothelioma Project (ChiMP) was launched on 1st February 2008 and ran for one year. The aim of the project was to find out what chemotherapy treatment mesothelioma patients were being prescribed, how much chemotherapy was available and where each was on offer. The project was carried out in England.
It was hoped that once completed, ChiMP would assist health care funders to assess the cost impact of chemotherapy treatment for mesothelioma patients and possibly lead to guidelines being introduced for the treatment of mesothelioma.
736 patients were entered into the audit and of these, complete data was collected from 681.
The audit looked at the characteristics of mesothelioma patients:
- 83% were male;
- 56% were aged between 61 and 75;
- 56% had right sided pleural disease;
- 57% had epitheliod tumours.
Out of the 681 patients entered into the audit, 364 received chemotherapy.
Huge regional variation was seen and the percentage of patients given chemotherapy ranged from 0% to 100%. The highest percentages were seen in South London and Birmingham. The lowest percentages came from Cheshire and Merseyside.
The type of chemotherapy offered also varied:
- 60% were treated with a combination of Pemetrexed and Cisplatin;
- 28% were treated with Pemetrexed and Carboplatin;
- 2% were treated with Pemetrexed alone;
- 9% were treated with other chemotherapy.
It was found that, as would be expected, in the younger age groups a higher percentage of patients were treated with chemotherapy:
- 83% of patients aged below 50 were given chemotherapy;
- 25% of patients aged between 76 and 80 were given chemotherapy;
- 14% of patients aged 81 or above were given chemotherapy.
Side effects and toxicities were also noted although reported toxicities were low. It is thought that this was due to underreporting rather than patients not experiencing them. The most reported side effect was nausea but patients also experienced constipation, anaemia and vomiting.
It is thought that ChiMP is the largest survey to investigate chemotherapy usage in routine clinical practice. The project highlighted important issues and showed the typical characteristics of mesothelioma patients. There were surprising results with regard to the numbers of patients who were treated with chemotherapy but of these, symptom improvement was achieved by many.